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5
25
Glucometer Elite
®
XL
section
25
I2
Check List
1. The Meter serial number is: _________
2. The date and time the problem
occurred was: _________
3. I tested with both the Check Strip and with the
Glucometer Elite
®
Normal Control:
Yes____No____
• The Check Strip result was: _________
• The Normal Control result was: _________
4. The Normal Control Range listed on the end flap
of the Test Strip carton is: _______ to _______
5. The Code Number being displayed on the Meter
is: F- _________
The Code Number on the Code Strip and on the
Test Strip foil packet currently being used is:
F- _________
6. Please include the lot number and expiration
date of the Test Strips and Controls currently
being used. For the Test Strips, this information
is printed on the carton as well as on the back
of each foil packet. For the Controls, this infor-
mation is printed on the bottle.
Lot Number:
Expiration Date:
Test Strips Control